the manicure

My mom went into hospice care on Thursday afternoon, transported on a gurney in an ambulance from the hospital where she had been for the past week. She was pretty sleepy when I first saw her there, tucked neatly into the bed. The room was beautiful, just the type of thing my mom liked, brand new and clean. There was a huge window out to a field where birds flew happily by and you could see a thunderstorm building off in the distance. After I had sat with her a while, she said; "Get out of here!" so I stayed just a little bit longer, and then went home. I took the next day off of work to try to get her settled in.

When I visited the next morning the nurse was in a happy mood, saying my mom was well and they had even seen a fawn grazing in the field outside the window. I entered the room and she was sitting up in the bed eating a ham and cheese omelet and communicating much better than usual. I was astonished. I worried we had made the wrong decision. I tried to talk with her throughout the day, trying to reach her to get her to understand the situation. I told her she was dying. She said; "No!" I explained to her that she had a giant cancerous tumor growing on her liver. She just pishawed me. Then I asked her if she was ready to go be with daddy (who died 6 years ago) and she again said; "No!"

These exchanges worried me very much. I talked to a counselor at the hospice center and they assured me that this rebound was a normal sequence of events, and the resistance and fear I heard in her voice was natural. She was afraid to die. I guess that sounded right to me. Why did I assume she would lay back and go peacefully? Why did I think some fantastic grace would settle on her and she would be sage and complacent about dying. The last thing she said to me was; "You aren't trying to get rid of me are you?" That will slice into my heart over and over forever. I assured her that I wasn't but her eyes blanked out again and she was in that hazy state of oblivion she's seemed to occupy for these last months.

I went home for a while and then came back to visit her later that evening. I'd hoped some others that I had called would have come to visit, but they hadn't. So I stayed until about 11 pm. She seemed to be doing OK, but had started going into a sleepy phase, which the doctor had warned me would happen; "She'll just fall asleep, the liver will start shutting down, and she will just fall asleep. Unless of course she has a seizure, and if that happens, we will try to make her as comfortable as possible. For now we'll give her something for her pain and anxiety." That was comforting, I think.

I returned Saturday morning to see how she was. She was barely conscious and hadn't eaten a thing. I began to be concerned. I decided to go to the nursing home and get her a few things to make her feel more comfortable, a blanket, some photos. My sister was coming later to check mom out of the nursing home and clean the room out. So I drove to Stoughton and back and when I returned with some of her things, they told me mother had thrown up. The began to talk of her decline and told me what to expect. I stayed with my mom until my sister came. I asked if she was staying overnight and she said that she couldn't, she had to work, and it's hard to find someone to work that shift, so she would be returning to Sturgeon Bay that afternoon. They mainly seemed concerned about mom's stuff, and asked me whether I wanted it, or should they just drop it at the Goodwill. I said I'd take her stuff to my house. Then I tried to talk with my sister alone, but her husband who is kind of mean (mean Dean), wouldn't let us be alone, he kept hovering over her. So it was useless to try to be intimate with her. They really wanted to make sure that I didn't leave without mom's stuff, and they even would help me load my car. So I'm getting really pissed. First she isn't staying, and then they're more concerned about getting the stuff out of the car than in mom's condition.

I went out and loaded my car and drove home. I was anxious and couldn't focus. My only relief came in the form of pulling weeds in the back yard. I think I was out there for four hours. My brother called and said he was there with mom now, but would be leaving in an hour. So I decided to go back and see how she was doing, stay for a while and then go see my friend's band play at a local bar. I didn't shower before I went to see mom, thinking I would after. But when I got to the hospice center I found mother in a terrible state. Very out of it. They said she had thrown up again, old blood. They said she had the signs of immanent death, her legs had a bluish modeling, her breathing was labored and crackly, and she was in and out of a very low level consciousness. I couldn't leave her.

I sat with her, and tried calling people to tell them to come tonight if they wanted to see her again before she died. My uncle, aunt and cousin came at about 10 pm. Nick the pastor came around midnight. He had been at the Rhythm and Booms fireworks display and I could smell the alcohol on his breath. But he was sweet and blessed my mom. I joked with him that if she died tonight it would be just like her to go out with a bang.

Her breathing was getting heavier and it was no longer crackly, just a steady draw. After Nick left I decided to try to sleep a bit 'cause I was so tired. So I pulled out the wacky hide-a-bed thing and tried not to listen to every breath my mother heaved. I slept an uneasy sleep for about 3 hours.

I got up when the RN came in at 4 am to check her. He said things were progressing towards her end and that it wouldn't be long. I set up a chair next to her bed and tried to hold her hand through the bed railing. Thankfully at 6 am when the next shift nurse came on she took those down as my mom hadn't moved for over 12 hours. I was grateful to her for that. Now I could easily hold my mom's limp hands, face her and talk to her, telling her it would be OK, telling her that I loved her, trying desperately to inject her with a positive spirit.

I happened to peer out the window and there in the meadow, up on the hill was the little fawn the nurse had mentioned she saw on Friday morning. I tried to show my mom, but she was too far gone to take it in. A moment later, the fawn ran off up the hill, it's white flag of a tail flapping as it leapt over the tall grass.

I dared to go get some breakfast at around 8 as I was beginning to shake and get dizzy from not eating. I hurried back to the room and she was still hanging in there. I ate only half of my meal. The food tasted flat and grainy. It wasn't the cooking, it was the situation, it could have been the greatest meal on earth and it would've tasted like dirt under these circumstances.

I set the plate aside and began to try to be completely in the moment. I drew her picture. I touched her skin. I talked quietly to her, telling her how sorry I was for everything, and how I wished I'd have been a better daughter, and not been such a disappointment to her. Tears mingled with these confessions. And still the heaving breath continued. It is like the kind of breathing when someone is paralyzed and they are on a machine that helps them breathe. The whole chest cavity moves up and the shoulders move up and then the breath is pushed out slowly.

As the day wore on, I started getting self-conscious about my personal hygiene. I called someone to bring me some new clothes so I could take a shower there. I waited for them to come and sat with my mom some more. I was starting to get bored. I hate to admit that, but I had been there a long time just listening to her breathe. The doctor came in and said her heart was beating very fast. He said that was another sign of the end. So I sat and watched and listened. At some point I noticed my finger hurting. It was a bad hangnail. So I rummaged through my stuff and found a fingernail clipper. I clipped off the offending nail fragment and as I did that, I remembered thinking that mom's nails could use some work. She had even asked me to bring her emery board to the hospital, so I thought she might appreciate a little manicure.

I took her limp hand in mine and started cleaning the junk out from under her fingernails. Then I trimmed the corners off and made the nail look nice. I lifted each pudgy edematous and pale finger, taking care to make them look as nice as possible. I looked to her for approval and asked her if she liked it. Her eyes shifted weekly, and I took that as a "yes." I continued with the other hand. I did the thumb first, then the index finger, and on down the line. As I was finishing the pinky her breathing slowed. There was a long gap before the next breath. I looked at her face, there was no expression. There was only silence. My heart started to pound. I was very scared. I untangled myself from the recliner that wouldn't fold back up, reached for the nurse button, pressing it in a panic. No one came immediately. Seconds were like minutes. I went to the hall and looking toward the nurses station, beckoned the nursing assistant to come; "I think my mom has passed!" I said, trying to hold back hysterical tears.

She got up, came around the counter and walked with me toward the door to room 44 where my mom lay. We entered the room and I was surprised to see my mom's chest heave. Another nurse came and listened to my mom's chest. She said; "There's still a heartbeat." There was another breath as I wound around the bed and over the recliner which I still couldn't get to fold back up. The nurse encouraged me to talk to my mom, and to hold her hand and tell her that I loved her. So I did. And that was the end. There were no more breaths. No more heartbeats. No more suffering for my mom.

They let me stay in the room with her for a few more minutes, and I watched as the death pall set into her face. I told my friend Cynthia that it was kind of like watching a sunset, you aren't really sure when it actually gets dark, but you know when night has fallen. And there it was, the night was upon her. The permanence was palpable.

A few minutes later they arrived with my clean clothes. Simon was with them. He cried. The nurses cleaned mom up and Simon was allowed to come in the room, hold grandma's hand and give her one last kiss. Amen.